AMID DEATHS, TALES OF TECH SAVING LIVES IN UP
That India is a country of extremes is perhaps best highlighted by how public healthcare is delivered and monitored.
On the one hand, you have children dying in Gorakhpur, where oxygen supply was discontinued at the peak of the annual encephalitis outbreak that sickens several thousands and kill hundreds during the monsoons each year.
On the other, you have technology solutions being successfully used to ensure there is no shortage of quality vaccines. The system is so efficient that several countries in Asia, including the Philippines, Indonesia, Bangladesh, Nepal and Thailand, are keen to adopt it.
Scores of children die each year in the 955-bed BRD Medical College in Gorakhpur, which is the referral hospital for all encephalitis-affected districts in the densely populated Terai region of Uttar Pradesh and Bihar.
This year, it made headlines for losing more than 30 children to encephalitis within 24 hours. So desperate are parents of sick children that, more than doctors and treatment, they trust the healing powers of a peepal tree outside the encephalitis ward, where they pray each day for their child to live.
In the same district of Uttar Pradesh (UP), a smartphone app called Electronic Vaccine Intelligence Network (eVIN) is being used to track vaccine stocks and supply and maintain cold-chain temperatures to ensure quality and efficacy are not lost to temperature variations.
UP is one of 12 states in India using eVIN to digitise vaccine inventories and recordkeeping at nearly 10,500 vaccine stores and cold chain points across 371 districts.
The system has been so successful over the past two years that it is being be scaled up to all 707 districts in India’s 29 states and seven union territories by 2021.
India has started leveraging smart technology to offer social-sector solutions. “There has been significant progress in understanding how fast data can move and how valuable that speed can be in personalising information and making connections between data sets, for better and more informed decision-making,” writes Nachiket Mor, director of the India Country Office of the Bill & Melinda Gates Foundation (BMGF).
Highlighting the eVIN success in a letter, Mor shared examples of simple innovations and smart technologies being used in India to improve lives.
“The accuracy of old-fashioned paper records was unreliable, and because information took weeks to reach central offices, no one knew how long stock-outs might last or when faulty equipment would be working again. eVIN has removed many of the weaknesses inherent in the paperbased system,” said Mor.
“Data shows that vaccines stock-outs have fallen by half in states where eVIN is in place, and it may soon be deployed for other medicines.”
EVIN is an online real-time logistics management system that tracks temperature and movement of vaccines across some of India’s most populated states. Sensors in refrigerators and freezers storing vaccines automatically inform a central database when temperatures change, signalling that the equipment needs to be repaired or replaced.
It provides an overview of stock too, to allow managers to move supplies to units running low, both from a central location and from overstocked centres nearby. Using digital technology is the way ahead. The eVIN initiative, which is run by India’s Ministry of Health and Family Welfare along with UNDP and NGO partners, including GAVI and the Gates Foundation, logs over 2 million vaccine transactions online on the eVIN server every month.
This didn’t happen overnight. The process involved training more than 17,000 government staff, including vaccine store keepers, data entry operators and cold chain handlers through more than 550 batches of training programmes; improving record-keeping by standardising stock and distribution registration, ensuring accurate temperature monitoring by installing temperature loggers, and closely monitoring vaccination coverage rates, among other measures.
Poor infrastructure, human resource shortages, weak regulation and monitoring and lack of accountability are critical constraints to public health delivery. The lesson from eVIN is that with planning and monitoring, it’s possible to provide quality services in low-resource network settings.
What’s also needed is the will to save lives. People deserve better. No child should die because public health specialists failed to predict and plan for outbreaks, or because hospitals fail to provide lifesaving medicines and services to those who need it.